The French Referral Centers for Complex Bone and Joint Infections (CRIOAc) 18 years after their establishment: Organization, added value, and future perspectives - 08/08/26
, Éric Senneville c, d, Johan Courjon e, f, Gwenaël Le Moal g, h, Harold Common h, i, Véronique Dubois j, k, Anne-Laure Roux l, m, Benoît Brunschweiler d, n, Adrien Lemaignen h, o, Jean-Yves Jenny p, q, Simon Marmor m, ron behalf of the French CRIOAc Network
Abstract |
Background |
Complex bone and joint infections (BJIs) represent a major public health challenge because of their severity, functional consequences, and the complexity of their management. In 2008, France established a nationwide network of Referral Centers for Complex Bone and Joint Infections (CRIOAc), a pioneering organization based on specialized multidisciplinary team (MDT) meetings and comprehensive national territorial coverage.
Methods |
We conducted a nationwide descriptive study of the CRIOAc network, assessing its activity and evolution since its establishment, including organizational changes, funding mechanisms, scientific output, and academic activities. Data were extracted from the national CRIOAc information system, which prospectively records all cases discussed during MDT meetings. A descriptive bibliometric analysis of publications citing the seminal CRIOAc article was also performed.
Results |
The network expanded from 8 coordinating referral centers at its inception to 32 accredited centers in 2024, providing nationwide coverage. It is governed by a National Scientific Committee representing all specialties and geographic regions. Since its creation, 64,859 patients have been managed within the network. The annual number of MDT meetings increased from 698 in 2011 to 1760 in 2024, while the number of surgical admissions for BJI increased from 6148 to 11,340 over the same period. The proportion of cases classified as complex remained stable at approximately 60–65%. The CRIOAc network has contributed to the development of national and international clinical guidelines, the establishment of a national inter-university diploma, the conduct of multicenter research projects, and the implementation of innovative phage-related anti-infective therapies. Bibliometric analysis demonstrates the growing international dissemination of the CRIOAc model.
Conclusions |
Eighteen years after its establishment, the CRIOAc network represents a pioneering and sustainable national model for the multidisciplinary management of complex BJIs, whose core principles are now supported by the international literature. Its mission has expanded beyond specialized clinical care to encompass research, education, and the evaluation of innovative therapeutic strategies. Further integration into European collaborative networks could strengthen its contribution to improving the management of complex bone and joint infections.
Level of evidence |
IV; Retrospective study.
Le texte complet de cet article est disponible en PDF.Keywords : Complex bone and joint infection referral center (CRIOAc/accredited expertise/complex infection pathway), Host-related complexity (severe comorbidities/immunosuppression/high anaesthetic risk/drug allergy), Microbiological complexity (difficult-to-treat microorganisms/antimicrobial resistance/rare pathogens), Surgical complexity (bone resection/joint resection/soft-tissue reconstruction/major bone loss), Relapsing bone and joint infection (treatment failure/persistent infection/recurrence after surgery or antibiotics), Innovative anti-infective management (phage therapy/compassionate access/biofilm-targeted local delivery)
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